Active NPI
Douglas Bruce McKeag, MD, MS
- Sports Medicine (Family Medicine) Physician
- Portland, OR
National Provider Identifier
1871558353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- MD167303
- Practice address
- 4411 SW Vermont St
Portland, OR 97219-1020 - Phone
- (503) 494-9992
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | MD167303 | OR | Primary |
Addresses
Primary practice location
4411 SW Vermont St
Portland, OR 97219-1020
Mailing address
4411 SW Vermont St
Portland, OR 97219-1020
Phone (503) 494-9992
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200259190 | Medicaid | IN | |
| P00800740 | Other | IN | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD167303 | OR | MD | Sports Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406246400000",
"number": "1871558353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 SW VERMONT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972191020",
"telephone_number": "503-494-9992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 SW VERMONT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972191020",
"telephone_number": "503-494-9992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKEAG",
"first_name": "DOUGLAS",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "MD, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2014-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "OR",
"license": "MD167303",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200259190",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00800740",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.